Using My Insurance
Here are some frequently asked questions and answers regarding insurance.
Will you bill my primary and secondary insurance?
You will need to provide us with complete primary insurance information. As a courtesy to our patients, Mercy submits bills to your insurance company and will do everything possible to advance your claim. However, it may become necessary for you to contact your insurance company or supply additional information to them for claims processing requirements or to expedite payment.
Why did my insurance deny the claim?
One or more of the following may apply:
- The service you received was not covered under your plan.
- You did not provide the correct insurance information at the time of service.
- The service you received was from a physician outside your plan's network.
- You were not covered by your plan at time of service.
- Your primary care physician did not process a referral for the services or an authorization was not obtained prior to the services being rendered.
Why did my insurance company only pay part of my bill?
Most insurance plans require you to pay a deductible and/or co-insurance. In addition, you could be responsible for non-covered services. Please contact your insurance company for specific answers to your questions. You may have out-of-pocket expenses.
Why do I need to call the insurance company if they do not pay the bill?
If you have a PPO policy, you are ultimately responsible for the total bill or any portion of the bill your insurance carrier does not pay. The Central Billing Office will make every effort to resolve the account balance with your insurance carrier. Occasionally, we will be unable to resolve the issue with your carrier and will need your assistance.
If I have an HMO policy, can I be billed if they do not pay?
If you have an HMO policy, you should only be billed for the amount specified on your explanation of benefits (EOB) that is provided to you by your insurance carrier. This usually includes co-pay amounts, deductibles and non-covered services.
I belong to a managed care plan. What should I do before coming to the hospital?
Read your insurance plan booklet to be sure you have followed all the guidelines for referrals and authorizations, or call your insurance for assistance. Failure to follow your plan requirements may result in greater out-of-pocket expenses for you. Your primary care physician plays a very important role in this process. If you receive a verbal authorization number, please provide us with this information at registration.
I belong to a managed care plan but needed to be seen in the emergency room; what should I do now?
After receiving services, if you did not contact your primary care physician or your insurance plan before you came to the emergency room, you will need to contact them within 24 hours explain the circumstances and ask for authorization.
How do I know if my health plan includes Mercy Medical Center or MercyCare Community Physicians?
Mercy participates in most major health plans in our community. In addition, please review your health plan provider directory and/or consult with your health plan to confirm coverage.
How will Mercy Medical Center or MercyCare Community Physicians know in which health plan I participate?
Please present your current health plan identification card when you register for inpatient or outpatient services at Mercy.
What is the difference between an HMO and a PPO?
Health Maintenance Organizations (HMOs) require a patient to select a Primary Care Physician to coordinate his or her care. Most HMOs provide care through a network of hospitals, doctors and other medical professionals that, as a patient, you must use to be covered for that service.
Preferred Provider Organizations (PPOs) provide care through a network of hospitals, doctors and other medical professionals. When patients utilize healthcare providers within the network, they receive a higher benefit and pay less money out of their pocket. Services received by a non-participating hospital or doctor may still be covered, but often at a reduced benefit level.
What does "in-network" and "out-of-network" mean?
If you receive your health care services from a hospital, physician or other healthcare provider that participates in your health plan, they are often referred to as "in-network." Hospitals, physicians or other healthcare providers who do not participate in your health plan may be referred to as "out-of-network." See more about common insurance terms.
How do I know if my health plan requires a referral or pre-certification for a service?
Your benefit book or provider directory should provide this for you. If not, call the customer service phone number listed on your insurance identification card.
What should I do if my health plan includes Mercy Medical Center or MercyCare Community Physicians as a participating provider, but I receive an explanation of benefits stating I am out-of-network?
Consult your health plan.
What if I have questions on my bill?
If you have questions about your Mercy Medical Center bill, or feel that it is incorrect, call (319) 369-4505 or email financialadvocate@mercycare.org between 7:30 a.m. and 5 p.m. Monday through Friday. Please have the Patient's name, account number(s) listed on the bill or the patient's social security number ready when you call.
